HomeMy WebLinkAbout200612 08/17/2011 CITY OF CARMEL, INDIANA VENDOR: 365616 Page 1 of 1
ONE CIVIC SQUARE AMUDHA SAMUEL
CARMEL, INDIANA 46032 3336 KILKENNY CIRCLE CHECK AMOUNT: $48.00
CARMEL IN 46032
CHECK NUMBER: 200612
CHECK DATE: 8/17/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 48.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt 699256
Payment Date: 08/01/11
Household 9861
Monon Community Center Amudha Samuel Hm Ph: (317)733 -2222
Carmel IN 46032 3336 Kilkenny Circle
Carmel IN 46032 Cell Ph: (317)319 -3811
Phone: (317)848 -7275 amudhasamuel@gmaii.com
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 48.00
Enrollee Name: Aster Samuel Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 116425 -03 Safe Sitter 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 04/28/2011 (Cancelled)
Primary Instructor: CCPR Staff no 13 0 9 1^"/
Class Location: Program Rms A, B, C Class Dates: 08/20/2011 to 08/20/2011 J�
Monon Community Cntr 9:OOA to 4:OOP A
Sa AUG 0 4 2011
Carmel IN 46032 Scheduled Sessions: 1
(317)848 -7275
Cancel Reason: advanced request`'
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 08/01/11 15:32:06 by LVA FEES CHANGED ON CANCELLED ITEMS 55.00
SURCHARGE APPLIED AGAINST CANCELLED FEES Z.00-
NET AMOUNT FROM CANCELLED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 4850
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 48.00 Made By REFUND FINAN With Reference advanced request
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
iss* Authorized d N ash or cre 't card refunds.
Sigq lure Date Authgn Gn ure D to
Join us for St. Vincent Tour de Carmel, a bike ride along 10 -mile and 20 -mile routes through the city of Carmel. Rest stops will
have a variety of healthy snacks, drinks and entertainment. After the ride, the finish line will offer more entertainment and
refreshments. The cost is $8 per rider ($10 for same- dayday -of registration). Pre- register online at www.carmelclayparks.com
or pick up a form at the Monon Community Center. All participants will receive a goodie bag and a T -shirt if registered on or
before August 26.
The Adaptive 10 -mile Ride is for individuals with special needs only. Individuals will ride as a group on the 10 -mile route. Staff
will be staggered within the group throughout the ride. Group will meet at the Monon Community Center in the designated tent
at the start line for check -in at 8:00 a.m. Group will begin the ride at 8:30 a.m. sharp.
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ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Samuel, Amudha Terms
3336 Kilkenny Circle Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/1/11 699256 Refund 48.00
Total 48.00
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20_
Clerk- Treasurer
Voucher No. Warrant No.
Samuel, Amudha Allowed 20
3336 Kilkenny Circle
Carmel, IN 46032
In Sum of
48.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1096.42 699256 4358400 48.00 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
9 -Aug 2011
1 A "fm
Signature
48.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund